Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice docx

confident that the publication of Working Together: Aboriginal and Torres Strait Islander Mental Health and Wellbeing Principles and Practice marks a watershed in the treatment of Indi

confident that the publication of Working Together: Aboriginal

and Torres Strait Islander Mental Health and Wellbeing

Principles and Practice marks a watershed in the treatment of

Indigenous mental health issues.’

Tom Calma

Aboriginal and Torres Strait Islander Social Justice Commissioner

‘Embracing the principles and practices in this textbook

Minister for Indigenous Health, Rural and Regional Health &

Regional Services Delivery Working Together: Aboriginal and Torres Strait Islander Mental

Health and Wellbeing Principles and Practice was funded by the

Office for Aboriginal and Torres Strait Islander Health, Australian

Working Together:

Aboriginal and Torres Strait Islander

Mental Health and Wellbeing Principles and Practice

Editors: Nola Purdie, Pat Dudgeon and Roz Walker

© Commonwealth of Australia 2010

This work is copyright Apart from any use as permitted under the Copyright

Act 1968, no part may be reproduced by any process without prior written

permission from the Commonwealth Requests and inquiries concerning

reproduction and rights should be addressed to the Commonwealth Copyright

Administration, Attorney-General’s Department, Robert Garran Offices,

National Circuit, Barton ACT 2600 or posted at http://www.ag.gov.au/cca

Jonelle (Nellie) Green was born in Morawa, Western Australia Nellie’s people are the Badimaya people (Yamatji mob) who were traditionally located east of Geraldton She is the fourth eldest in her family with two brothers and three sisters Nellie has worked in Indigenous Higher Education for over 15 years and is Manager of Indigenous Student Services at La Trobe University, Melbourne She is a graduate of Curtin University, Perth, and undertook her Honours year in 2009 She is also an Aboriginal artist and is a keen activist involved with Indigenous social justice and human rights issues.

Other artwork is reprinted with permission of Women’s Health Goulburn North East The six paintings are from the Making Two Worlds Work Project developed by Mungabareena Aboriginal Corporation and Women’s Health Goulburn North East, 2008 They depict aspects of Aboriginal health and wellbeing The themes are: spiritual and mental health, kinship and family, culture and identity, physical health, practical support and understanding, and partnerships with health and community agencies

http://www.whealth.com.au/ourwork/mtww/mtww_posters.html

Part 2: Issues of Aboriginal and Torres Strait Islander

 SueFerguson-Hill

Part 4: Working with Specific Groups:

17 Ngarlu: A Cultural and Spiritual Strengthening Model 245

 JoeRoe

18 Principled Engagement: Gelganyem Youth and Community 253 Well Being Program

I welcome the publication of WorkingTogether:AboriginalandTorresStraitIslanderMental

HealthandWellbeingPrinciplesandPracticeas an important contribution to the ongoing

struggle for the achievement of health equality between Indigenous and non-Indigenous

Australians, and I thank the Australian Government for funding and initiating the project

under the 2006 $1.9 billion COAG Mental Health Initiative

This book stands to make an enormous contribution to the mental health of Indigenous

Australians, for so long a subject bedevilled by the inappropriate application of non-Indigenous

models of mental health, models that so often failed to account for our unique experiences and

the significantly higher burden of poor mental health found in our communities

Indeed, for many years there have been calls for new approaches to Indigenous

mental health that identify and acknowledge what makes us different from non-Indigenous

Australians—the resilience that our cultures give us on one hand, and, on the other, the collective

experience of racism, the disempowerment of colonisation and its terrible legacy, and the

assimilationist policies that separated us from our families, our culture, our language and our

land This book is to be welcomed for meeting this long overdue need

I am particularly pleased that the editors— Nola Purdie, the Australian Council for

Education Research and Pat Dudgeon and Roz Walker, the Telethon Institute for Child Health

Research—ensured that Indigenous mental health experts led the development of each chapter

to ensure that Indigenous voices are heard, loud and clear, in its pages

Designed for practitioners and mental health workers, as well as students training to be

mental health workers, I am confident that the publication of WorkingTogether:Aboriginaland

TorresStraitIslanderMentalHealthandWellbeingPrinciplesandPractice marks a watershed in

the treatment of Indigenous mental health issues

I urge all students of health and education to read this book to gain a real appreciation

of the issues that may confront you when working with Indigenous people wherever they live

in Australia

This publication stands to make a substantial contribution to the achievement of

Indigenous health equality in Australia as we move into the 21st century I commend it to you

Tom Calma

FormerAboriginalandTorresStraitIslanderSocialJusticeCommissioner

2010

I am pleased to show my support for this pioneering book ‘WorkingTogether-Aboriginaland

TorresStraitIslanderMentalHealthandWellbeing,PrinciplesandPractices’

This exciting new resource will prepare students and practitioners across a range of allied

health professions to meet Indigenous mental health needs when working in mainstream and

Aboriginal Medical Services

Embracing the principles and practices in this book will help the health workforce play its

part in achieving the commitment by all Australian governments to closing the life expectancy

gap between Indigenous and non-Indigenous Australians within a generation

The chapters within this book provide compelling evidence to show that just as addressing

the health gap requires simultaneous effort in housing, education and employment; improving

Indigenous wellbeing means tackling more than just physical illness

Around 70 per cent of Indigenous deaths occur before the age of 65, compared with 21

per cent among non-Indigenous Australians, and so many early deaths tear at the fabric of a

community and have lasting impacts on the mental, social and cultural health of a family

Initiatives to grow and support the Indigenous health workforce and improve the social

and emotional wellbeing and mental health of Indigenous communities are vital to efforts to

reduce Indigenous disadvantage

The book provides the reader with exposure to strong views relating to social and

emotional wellbeing and mental health I hope it will stimulate interesting discussion amongst

students and practitioners of Indigenous mental health and wellbeing

I commend the mental health experts who have contributed their invaluable knowledge

and experience within these pages and I look forward to working with future health practitioners

and mental health workers as they take up their careers improving the health of Aboriginal and

Torres Strait Islander people

The Hon Warren Snowdon MP

MemberforLingiari

MinisterforIndigenousHealth,RuralandRegionalHealth&

RegionalServicesDelivery

2010

This book would not have come to fruition without significant collaboration and the sustained energy, ideas, support, and input of many people.

The editors would like to thank:

• Foremost, the important contribution of all authors, who volunteered their time and shared their expertise, is acknowledged with gratitude and admiration

• The Australian Government which funded the project

• The members of OATSIH’s Expert Reference Group for the COAG Mental Health

‘ImprovingtheCapacityforWorkersinIndigenousCommunitiesinitiative’ for their advice

Dr Robert Parker The Royal Australian and New Zealand College of Psychiatrists

Ms Stephanie Gilbert Australian Association of Social Workers

Ms Leanne Knowles Mental Health Council of AustraliaProf Ernest Hunter Psychiatrist

Assoc Prof Helen Milroy PsychiatristAssoc Prof Pat Dudgeon Australian Psychological Society

Dr Kathy Brotchie Royal Australian College of General Practitioners

• Australian Council for Educational Research (ACER) staff who assisted with a range of tasks

We are especially grateful to Gina Milgate, Indigenous Research Fellow, for her major contribution in assisting with coordination and liaison activities throughout the project Other valuable contributions were made by:

• The Telethon Institute for Child Health Research (TICHR) and the Kulunga Research

Network (Indigenous arm of TICHR) staff who contributed valued professional and

administrative support to the project

• The ACER Standing Committee on Indigenous Education and a specially constituted

Internal Reference Group who provided ongoing guidance and feedback on chapter

drafts Particular assistance was provided by Dr Ken Wyatt, the Director of the Office of

Aboriginal Health, Department of Health, Western Australia

• The chapter reviewers who provided informed and helpful comments on draft chapters

Jacquelyn Cranney School of Psychology, University of NSW

Stephen Meredith The Southern Adelaide Health Service Child and Adolescent

Mental Health Service (SAHS-CAMHS)Louis Peachey Mount Isa Centre for Rural and Remote Health, James Cook

UniversityBeverley Raphael School of Medicine, University of Western Sydney

Carrington Shepherd Kulunga Research Network, TICHR

• The market testers and their students who commented on the usefulness of the book for a

range of audiences

• The copyeditor, Venetia Somerset, who graciously and competently assisted with the task

of preparing the manuscript for publication

Yolonda Adams

Yolonda Adams is an Aboriginal psychologist and a Larrakia woman She is from Darwin in the Northern Territory and comes from a very large extended Indigenous family Yolonda graduated from Charles Darwin University in 1999 and became a fully registered psychologist in 2002 She is a member (and a steering committee member) of the Australian Indigenous Psychologists Association.Yolonda has worked in the public and private sector and has most recently worked with Mental Health Services where she provided a service to clients in a community setting who have serious mental illness and complex needs, including assessments of risks and needs to assist

in developing care plans She has many years of clinical experience with a diversity of clients, with significant experience working with Indigenous clients from urban, rural and remote communities in various employment positions Yolonda is particularly committed to providing culturally appropriate practice in assessment and intervention of Indigenous people’s wellbeing, especially in the area of mental health

Dr Caroline Atkinson

Caroline Atkinson currently lives in Papua New Guinea, undertaking community development work with a focus on trauma and violence Her Bachelor of Social Work at the University of South Australia achieved first class honours, with a thesis focusing on violence against Aboriginal women She then completed a placement in Tamil Nadu, India, researching the specific issues and needs of adolescent girls Following this she headed a small team at a drug and alcohol rehabilitation centre

in Katherine, NT, before completing her PhD in Community Psychology focusing on Aboriginal male violence and its relationship to generational post-traumatic stress disorder While completing her PhD, Dr Atkinson formed Caroline Atkinson Consultancy Services, specialising in multi-method research approaches with a focus on violence and trauma issues In the course of her career

Dr Atkinson has written numerous papers for various organisations and publications and her PhD

is due to be published in book form in 2010 Caroline is the daughter of Professor Judy Atkinson, renowned for her work in trauma and family violence in Aboriginal Australia She is married to David and has a daughter and son who are twins

Professor Judy Atkinson

Professor Judy Atkinson identifies as a Jiman/Bundjalung woman who also has Anglo-Celtic

and German heritage With a PhD from Queensland University of Technology, her primary

academic and research focus is in the area of violence and relational trauma, and healing for

Indigenous and indeed all peoples Having developed a Diploma in Community Recovery, an

undergraduate degree in Trauma and Healing, a Masters in Indigenous Studies (wellbeing),

and a Professional Doctorate in Indigenous Philosophies, she is presently focused in her role

as Director of the Healing Circle (Collaborative Indigenous Research Centre for Learning and

Educare) The centre links community and university, building pathways between teaching

and research, with a belief that the science of teaching must have a research base, that research

can result in a practice based on evidence, and hence influence evidence-based policy for

better outcomes for Indigenous and indeed all Australians Judy is a member of the Indigenous

Clearinghouse Secretariat of the Scientific Reference Group of the Australian Institute of

Health and Welfare

Dr Marilyn Campbell

Dr Marilyn Campbell is an associate professor in the school of Learning and Professional

Studies, Faculty of Education at Queensland University of Technology She currently lectures

in the Masters of Education program preparing teachers for school counselling and in the

Masters of Educational and Developmental Psychology preparing psychologists to work in

a range of educational and developmental positions Marilyn has worked as a teacher and

psychologist in early childhood, primary and secondary schools She has also been a

teacher-librarian, school counsellor and supervisor of school counsellors Her research interests are

in behavioural and emotional problems in children and adolescents Her recent work has

included research into anxiety prevention and intervention as well as the effects of bullying

and especially cyber-bullying in schools She is the author of the Worrybusters series of books

for anxious children

Wendy Casey

Mrs Casey belongs to the Karajarri and Yawuru people and her extended family reside in

the West Kimberley region of Western Australia She is currently Manager of the Aboriginal

Alcohol and other Drug Program of the WA Drug and Alcohol Office For the last 20 years she

has specialised in the drug and alcohol field She has worked within the community-controlled

and government sectors, in metropolitan and remote area regions and in a variety of roles that

include managing clinical services, policy, workforce development, resource development,

community development and research Mrs Casey is a member of the National Indigenous Drug

and Alcohol Committee

Dr Kyllie Cripps

At the time of writing this chapter Kyllie Cripps was an Indigenous research fellow with the

Onemda Vic Health Koori Health Unit, Centre for Health and Society at the University of

Melbourne She has since accepted a senior lectureship at the Indigenous Law Centre, Faculty

of Law, University of New South Wales Dr Cripps’s research interests include issues relating

to Indigenous family violence, sexual assault and child abuse including policy development

and program/service delivery She is currently leading an ARC project called ‘Building and

supporting community led partnerships to respond to Indigenous family violence in Victoria’

Her PhD thesis was entitled ‘Enough Family Fighting: Indigenous Community Responses to

Addressing Family Violence in Australia and the United States’ In addition to her research

Kyllie has taught Aboriginal Health to nursing students and regularly provides policy advice to

the Australian and state governments She also provides training and support to professional

bodies and organisations dealing with the aftermath of violence

Professor Neil Drew

Neil Drew is Head of Behavioural Science and Dean of Arts and Sciences at the University

of Notre Dame Australia (UNDA) He is a social psychologist with over 25 years’ experience working with a diverse range of communities and groups He has worked with Aboriginal and Torres Strait Islander communities since beginning his career as a volunteer at the Aboriginal and Torres Strait Islander Medical Service in far North Queensland He was psychologist for the Department of Family Services in Queensland Before joining UNDA Professor Drew was Director of the University of Western Australia Institute for Regional Development At UNDA he

is the program head and co-founder of the AboriginalYouthandCommunityWellbeingProgram

in the East Kimberley, established in 2006 The Program is funded by the Gelganyem Aboriginal Trust and promotes wellness and suicide prevention for young people in East Kimberley

Aboriginal communities

Associate Professor Pat Dudgeon (author and editor)

Dr Pat Dudgeon is from Bardi and Gija people of the Kimberley She went to Perth to study psychology and afterwards joined the Centre for Aboriginal Studies at Curtin University of Technology She was appointed as the Head of the Centre for Aboriginal Studies at Curtin and provided leadership in Indigenous higher education for some 19 years Dr Dudgeon has also had significant involvement for many years in psychology and Indigenous issues She was the first convenor of the Australian Psychological Society Interest Group, Aboriginal Issues and Aboriginal People and Psychology, and has been instrumental in convening many conferences and discussion groups at national levels to ensure that Indigenous issues are part of the agenda in the discipline She has many publications in this area and is considered one of the ‘founding’ people in Indigenous psychology She was the chief editor

and major contributor of WorkingWithIndigenousAustralians:AHandbookforPsychologists

(2000, Gunada Press) She is the current Chair of the Australian Indigenous Psychologists Association and advisory member on the Public Interest Advisory Group of the Australian Psychological Society (APS) She was also awarded the grade of Fellow in the APS in 2008 Pat Dudgeon is actively involved with the Aboriginal community and social justice issues for Indigenous people She has participated in numerous community service activities of significance, was a member of the Parole Board of Western Australia for several years, and was a psychologist in the defence forces She recently completed her PhD in psychology She was appointed as an adjunct associate professor with the School for Indigenous Studies at the University of Western Australia and worked as a consultant In 2009 she was awarded a three-year post-doctoral fellowship to undertake research with Aboriginal and Torres Strait Islander women on women’s leadership

a component of a final thesis

Management roles and clinical practice in a community-based Family Care Centre

in Sydney saw a specialisation in the management of postnatal stress and depression in a community setting As a Nurse Educator at the College of Nursing in Sydney, Sue managed education programs in Child and Family Health Nursing and Midwifery and participated in training programs for Aboriginal Health Workers in communities in New South Wales and

Queensland Sue moved to the Kimberley in Western Australia in 2000 to undertake clinical

practice in Child and Family Health Nursing based in community health, providing the service

to Aboriginal communities in the West Kimberley over a period of six years

Further study through a Masters in Public Health and Tropical Medicine continued

a special interest in the identification and management of perinatal stress and depression in

Aboriginal and non-Aboriginal women living in remote settings, viewed from the perspective

of a public health issue, and noting the significant effects of perinatal stress and depression on

families and communities

Darren Garvey

Darren Garvey was born and raised in Cairns in northern Queensland, and his heritage

extends to and reflects the diversity of the Torres Strait Darren has a degree in Psychology

from James Cook University of North Queensland and postgraduate qualifications in Health

Promotions and Tertiary Education from Curtin University of Technology For the past 15

years he has worked at the Centre for Aboriginal Studies at Curtin, now lecturing in the

Indigenous Australian Cultural Studies Program He is presently pursuing his PhD on how

mental health professionals, students and Indigenous people construct the arena of Indigenous

mental health and negotiate their participation in it In 2000 he helped edit and contribute to

a handbook for psychologists working with Indigenous Australians, and recently published

Indigenousidentityincontemporarypsychology:Dilemmas,developments,directions (2007,

Thomson), which was shortlisted for the AIATSIS Stanner Award Darren is a devoted family

man and the proud father of Oliver and Elliot

Graham Gee

Graham Gee is a descendant of the Garawa nation and grew up in Darwin Originally trained as a

schoolteacher in 1993, Graham taught Physical Education internationally in the United Kingdom

before working with Indigenous students in northern New South Wales and with the Batchelor

Institute of Indigenous Education as a remote community lecturer in the Northern Territory

In 2000 he realised that he was most passionate about trying to understand how people

navigated their own healing processes, and he was inspired to learn more about the similarities

and differences in the way Aboriginal Australians experienced and overcame adversity

compared to other cultures Graham began his studies in Psychology at Melbourne University

in 2002, while also working part-time at Native Title Services Victoria His role there involved

coordinating native title meetings for Victorian Traditional Owner groups, and he gained

particularly valuable experience while assisting the Victorian Traditional Owner Land Justice

Group to engage in (ultimately successful) negotiations with the Victorian Government to jointly

develop a Statewide Native Title Settlement Framework

In 2008, Graham began working as a counsellor at the Victorian Aboriginal Health

Services, while also undertaking a combined Masters/PhD in Clinical Psychology at Melbourne

University His work at the Victorian Aboriginal Health Services primarily involves counselling

clients who have experienced trauma, grief and loss The focus of his PhD research is on trauma

and resilience in urban Koori communities Currently Graham sits on the steering committee

of the Australian Indigenous Psychologists Association, and on Stolen Generation Victoria’s

Partnerships in Healing advisory committee

Belle Glaskin

Belle Glaskin is a Nyungar-Bibbulmun woman from the south-west of Western Australia, and

she is also a clinical psychologist (Registrar)

Belle completed a Bachelor of Arts with Honours in Psychology at the University of

Western Australia in 2006 During her undergraduate years she was heavily involved in the

Western Australian Student Aboriginal Corporation, and was the Aboriginal and Torres Strait Islander Representative on the UWA Guild Council in 2004 In 2007, Belle was awarded the inaugural Bendi Lango Foundation Bursary, which was established by the Australian Psychological Society to support Aboriginal students in the completion of postgraduate studies

in psychology She completed her Master of Psychology (Clinical) at Curtin University of Technology in 2009 Her Masters thesis explored the role of social and emotional wellbeing in Aboriginal students’ school success in a Western Australian school-based resiliency program Belle has worked with Aboriginal people and the Aboriginal community in a range of areas including the government and private sectors, not-for-profit organisations, and voluntary work Her areas of professional interests include Aboriginal mental health, social and emotional wellbeing, resiliency, trauma and healing, grief and loss, suicide prevention and post-vention

Professor Dennis Gray

Dennis Gray is Professor and Deputy Director of the National Drug Research Institute

at Curtin University of Technology, where he heads the Institute’s Indigenous Australian Research Program He has conducted research projects on Indigenous health in general and Indigenous substance misuse in particular and is author of numerous publications in those areas He is particularly concerned with collaborative research and building Indigenous research capacity Professor Gray’s research has had practical outcomes for Indigenous people at the local, state and territory, and national levels; and he is a member of the National Indigenous Drug and Alcohol Committee - a committee of the Australian National Council

on Drugs and the peak advisory body on Indigenous substance misuse In 2006, his research team won the National Drug and Alcohol Award for Excellence in Research and a Curtin University Vice-Chancellor’s Award for Excellence

Heather Gridley

The middle of three sisters in a predominantly Irish-Australian family, Heather Gridley’s upbringing in an inner northern suburb of Melbourne revolved around her family, the parish church and her neighbourhood Her sociopolitical consciousness gathered momentum during the 1970s and since the 1980s has explicitly encompassed feminism and anti-racism Heather’s areas of specialist knowledge include community and feminist psychology, professional ethics, critical history of psychology, psychology and social justice Her interest in community psychology stemmed from her work in community health, where she became aware of the limitations of interventions directed solely at individuals

Heather coordinates one of Australia’s two postgraduate programs in Community Psychology, at Victoria University, Melbourne She has held national positions in both the APS College of Community Psychologists and Women and Psychology Interest Group, and she was a founding member of the Aboriginal and Torres Strait Islander Peoples and Psychology Interest Group She has served two terms on the APS Board of Directors, and is currently also working

at the APS as Manager, Public Interest, where she has oversight of psychology’s contribution to public debate and policy in the interests of community wellbeing and social justice

Darrell Henry

Darrell Henry has worked 20 years as a psychologist, predominantly in the areas of drug and alcohol abuse, Aboriginal family violence, and child sexual abuse He works with Aboriginal men, women and children in their families and communities, with a focus on healing Darrell’s Aboriginal grandmother country is with the Wunmulla people from the Canning Stock route in desert Western Australia Darrell was co-founder of the Yorgum Aboriginal Family Counselling Service (established 1994, in Perth) with a small group of senior Aboriginal grandmothers, and served for periods as Manager and Clinical Director Darrell was one of three panel members tasked with the 2002 Inquiry into Response by Government Agencies to Complaints of

Family Violence and Child Abuse in Aboriginal Communities, and a member of the advisory

committee for the 2007 Structural Review of the WA government department responsible for

child protection He was an inaugural member of Western Australia’s first Child Death Review

committee He is a former Deputy Chair of the WA Ministerial Advisory Council on Child

Protection Darrell has worked throughout regional Western Australia and currently works as a

clinician in Warmun and Narrogin He continues to train lay Aboriginal community people in

working clinically with chronic trauma and in old and modern ways of healing

Kerrie Kelly

Kerrie Kelly is a non-Indigenous psychologist who has worked for more than a decade with

Aboriginal and Torres Strait Islander colleagues in the area of social and emotional wellbeing, which

exists in a context of collective and transgenerational trauma To develop cultural competence in

this area, Kerrie entered into mentoring relationships with Aboriginal elders which continue today

Projects have included documenting an Indigenous counselling process and developing accredited

counsellor training to reflect this; developing cross-cultural training for mental health practitioners

and a co-counselling model to support remote Indigenous health practitioners to cope with

job-related trauma Kerrie has worked with the Marumali Journey of Healing program for many years,

which aims to improve the quality of support available to survivors of Stolen Generation policies

More recently, Kerrie coordinated a national project to identify mental health services which

encouraged help-seeking in urban, regional and remote Indigenous communities Kerrie is currently

working to support the steering committee of Indigenous psychologists to establish and develop the

Australian Indigenous Psychologists Association

Gina Milgate

Gina Milgate is an Aboriginal woman from the Kamilaroi and Wiradjuri clans of New South

Wales Gina has an undergraduate and postgraduate degree in marketing and management

and a teaching degree in higher education She is currently working at the Australian Council

for Educational Research in the area of Indigenous education Gina’s background in education,

marketing and management has helped her contribute widely to the community, in particular

through projects that create awareness, educate and inform key stakeholders, empower

Indigenous students, and promote social awareness In her role at ACER and through her

participation in Indigenous affairs, Gina contributes to programs and policies at local, state and

national levels that contribute to making a difference and improving outcomes for Indigenous

people Before her appointment at ACER, Gina was an academic at the University of New

England for six years where she was teaching and researching in the subject areas of Indigenous

organisational management, marketing, strategic planning and management, organisational

behaviour and principles of management She has also facilitated workshops with students in the

areas of motivation, building confidence, goal-setting, career-planning, health and wellbeing,

and has consulted with organisations Gina is also working with Mindmatters in delivering their

social and emotional wellbeing professional development workshops for schools and community

groups and stakeholders that have a focus on Indigenous people and culture

Maria Morgan

Maria Morgan was born in Broome, of Yawuru (Karajarri/Bunuba) heritage, and was raised in

Wyndham She was a Kimberley Development Commission Board member from 1996 to 2002

and was a founding member of the Wyndham Aboriginal Medical Service Maria was also part of

the Argyle Agreement negotiations and is currently Co-Chair of the Gelganyem Trustee Board

In addition she has served for many years on numerous community boards and committees

including Ngnowar Aerwah, Joorook Ngnarni and Garduwar With her husband Colin, she is

proprietor of Wundargoodie Aboriginal Safaris and an inaugural member of the WA Indigenous

Tourism Operators Committee State Board In 2006 she founded the Youth and Community

Wellbeing Program as a partnership with the University of Notre Dame Australia

Dr Jeff Nelson

Jeff Nelson is the Director of Research and Research Training at Southern Cross University’s Gnibi College of Indigenous Australian Peoples Jeff gained his undergraduate and postgraduate qualifications from the School of Psychology at the University of Western Australia before working in various locations in various roles in rural and remote communities Before commencing his current role, Jeff worked in the health, education and justice sectors in research and community development roles He is primarily focused on developing and using cognitive assessment tools to inform programs that achieve sustained health and educational benefits for Aboriginal and Torres Strait Islander people Dr Nelson is also working with Gnibi and its partnering communities to develop a model of community engagement that empowers and supports the positive changes that come from the upskilling of local people

Dr Yin Paradies

Dr Paradies is an Aboriginal-Anglo-Asian, born in Darwin, who has lived in Melbourne since 2007 He is a Research Fellow jointly at the Menzies School of Health Research and the University of Melbourne He has qualifications in mathematics and computing (BSc), medical statistics (MMedStats), public health (MPH), and social epidemiology (PhD) Yin’s research focuses on the health, social and economic effects of racism together with anti-racism theory, policy and practice for Indigenous Australians as well as migrants/refugees and their descendants He also teaches short courses in anti-racism and diversity to researchers and professionals in Indigenous and multicultural affairs Dr Paradies has received a range of awards including a Fulbright scholarship to study at the University of California, Berkeley, the Australia Day Council’s 2002 Young Achiever of the Year award, and Scholar of the Year in the 2007 National NAIDOC Awards

Associate Professor Robert Parker

Robert Parker is an Adjunct Associate Professor of Psychiatry at James Cook University and the Northern Territory Clinical School Associate Professor Parker initially completed an Arts degree, majoring in Anthropology and Prehistoric Archaeology before working on the Tiwi Islands in the Northern Territory for three years as an Aboriginal art and craft adviser

He then went on to study medicine and specialise in psychiatry In the course of his medical and psychiatric career he has had extensive clinical experience of Aboriginal and Torres Strait Islander health and mental health issues Associate Professor Parker is past chair of the Aboriginal and Torres Strait Islander mental health committee for the Royal Australian and New Zealand College of Psychiatrists and was also the previous Chair of the Board of Professional and Community Relations for the College He is married to Gregoriana, a Tiwi Aboriginal Health Worker, and they have three daughters

Lorraine Peeters

Like many Aboriginal and Torres Strait Islander children of her generation, Auntie Lorraine Peeters was forcibly removed from her family at the age of four and placed in an institution Through the healing journey necessitated by this traumatic event, she became involved with helping others from the Stolen Generation She developed the Marumali model of healing and in response to great demand she established a healing program called Winangali Marumali in 2000,

to support survivors of the Stolen Generation Participants are empowered by the workshop and its model of healing The program works in tandem with Link-Up, which allows Indigenous people to trace lost family members, and Bringing Them Home counsellors Recognising that those removed from their families are twice as likely to have been arrested, she also established the Marumali program in Victorian prisons Since 2002, more than 1000 participants have completed the program Auntie Lorraine Peeters also played an important role in the National Apology given by the Prime Minister in 2008 to the Stolen Generations Following the apology, she presented the Prime Minister with a glass coolamon, an Indigenous vessel for carrying

children, to thank him for offering the apology Auntie Lorraine Peeters has had a profound

impact on helping members of the Stolen Generation to heal

Dr Nola Purdie (editor)

Nola Purdie is a Principal Research Fellow and Coordinator of Indigenous Education Research

and Development at the Australian Council for Educational Research She is an Adjunct

Professor at the Queensland University of Technology where she was previously coordinator

of research methods and educational psychology courses, and Director of the Centre for

Cognitive Processes in Learning Before commencing a career in educational research, Nola

worked in state, Catholic, and independent schools in Western Australia in a variety of teaching

and administrative capacities for over 20 years She was the 2003 recipient of the Australian

Association for Research in Education Award for Excellence in Indigenous Research Nola’s work

in Indigenous education and related areas is guided by a social justice perspective, a valuing of

diversity, and a desire to promote informed policy and practice

Dr Debra Rickwood

Debra Rickwood is Professor of Psychology and Head of Department at the University of

Canberra, where she teaches research methods, developmental and social psychology She

researches in the areas of youth mental health and help-seeking, and promotion, prevention

and early intervention for mental health Debra is a member of the APS College of Community

Psychologists and is active in the society through membership of the Public Interest Advisory

Group and the Climate Change Reference Group She has been involved in developing mental

health and health policy for the Australian Government, including being the consultant writer

of the NationalActionPlanforPromotion,PreventionandEarlyInterventionforMentalHealth

(2000) and the NationalChronicDiseaseStrategy (2006) It is through these initiatives that Debra

has developed a growing interest in the impact of policy on the health and social, emotional,

spiritual and cultural wellbeing of Aboriginal and Torres Strait Islander Australians Debra has

also been involved in developing information and resources on mental health and mental illness

for Aboriginal and Torres Strait Islander peoples

Joe Roe

The late Mr Joseph Roe (Purungu by skin name) was a Karajarri/Yawru man His people are

also from the Broome and Bidyadanga area He completed a Bachelor of Applied Science in

Indigenous Community Health (Mental Health Counselling specialisation) in 1996 Mr Roe

worked in the area of Indigenous mental health for over 10 years, which included working with

the Aboriginal Visitors Scheme, Pinikarra Aboriginal Counselling Service and the Kimberley

Aboriginal Medical Services Council Mr Roe also worked as the Psych/Social Rehabilitation

worker with Northwest Mental Health Services in Broome His family has kindly given

permission for Mr Roe’s unique work to be reprinted so that his legacy can continue

Professor Sherry Saggers

Sherry Saggers is Professor and Project Leader at the National Drug Research Institute, Curtin

University of Technology, where she is establishing a research program on Prevention,Early

InterventionandInequality with an emphasis on child-focused, family and community-centred

models to address disadvantage She was formerly Foundation Professor of Applied Social

Research and the Director of the Centre for Social Research at Edith Cowan University An

anthropologist, she has worked with and for Indigenous communities across Australia for

almost 30 years She is best known for her research and publications on Indigenous health and

substance misuse, including the widely used textbooks Aboriginalhealthandsocietyand Dealing

withAlcohol:IndigenoususageinAustralia,NewZealandandCanada, both co-authored with

Dennis Gray She has also published on children and young people; allied health and community

services; and community development

Dr Clair Scrine

Clair Scrine is currently a Senior Research Officer at the Telethon Institute for Child Health Research She has been a member of a number of project teams involving research and evaluation with Aboriginal communities in Western Australia including the WA Aboriginal Child Health Survey, the Rio Tinto Child Health Partnership, the BHP-sponsored Substance Use Reduction project in the Hedland and Newman areas of the Pilbara, the review of the St John of God Health Care ‘Strong Women, Strong Babies, Strong Culture’ program in the Pilbara and the review of the Wheatbelt Health Service Before moving to Perth in 2006, Dr Scrine worked as a senior officer at the Office of Indigenous Policy Coordination and was previously a policy officer with the Aboriginal and Torres Strait Islander Commission (ATSIC)

Dr Scrine received her doctorate from Macquarie University in Sydney in 2003 During the completion of her doctorate she undertook a student residency at the Wellcome Trust Centre for the History of Medicine (within the University College of London) and at the University of Victoria, British Columbia, Canada

in October 1997 Memorial prizes in the name of Mark Sheldon have been established by the RANZCP and by his old high school Mark’s family has kindly given permission for his unique work to be presented in this book so that his legacy can continue

Professor Sven Silburn

Professor Silburn leads the program of developmental health and education research at the Menzies School of Health Research in Darwin where he is currently involved in the collaborative evaluation of the NT Department of Education and Training’s Transforming Indigenous

Education Strategy Before his appointment at Menzies in 2009, he was Co-director of Curtin University’s Centre for Developmental Health at the Telethon Institute for Child Health Research

in Perth Sven originally practised as a clinical psychologist with the WA Child and Adolescent Mental Health Service and became involved in Aboriginal mental health in the mid-1990s when

he chaired the WA Ministerial Council for Suicide Prevention’s working group on Aboriginal suicide prevention; this led to the WA Government instituting a $2 million across-government state strategy to reduce Indigenous suicide and self-harm from 2001 to 2003 He was one of the

chief investigators on the WesternAustralianAboriginalChildHealthSurvey, whose findings are

reported in four major monographs including a technical report on the measurement of mental health problems in Aboriginal children and young people, and the first independently verified population data documenting the nature and extent of the intergenerational effects of forced separation in Western Australia

Dr Christopher Sonn

Dr Christopher Sonn is a senior lecturer in the School of Sciences and Psychology at Victoria University, Melbourne He teaches in the areas of community and intercultural psychology and qualitative methodologies, at both undergraduate and postgraduate levels His work aims to contribute to theory, research and practice that make visible practices of racialisation and other

forms of exclusion as well as identifying resistant and resilient community responses, which are

central to promoting social change This has included exploring the sense of community and social

identity negotiation from the perspectives of immigrant and Indigenous people, examining the

dynamics of oppression and liberation in the context of intergroup relations, and developing critical

pedagogy for anti-racism This work draws on decolonising methodologies and critical whiteness

studies Papers based on this work have been published in refereed journals, including the Journal

ofCommunityPsychology,Race,EthnicityandEducation and the AmericanJournalofCommunity

Psychology He co-edited the books Psychologicalsenseofcommunity:Research,applicationsand

implications and PsychologyandLiberation:Theoryandapplications.

Annalee Stearne

Anna Stearne is a Nyungar woman from Western Australia with a background in education and

public health, and has been involved in researching Indigenous Australian substance misuse

issues since 2001 She is the manager of the National Drug Research Institute’s online resource,

Indigenous Australian Alcohol and other Drugs Bibliographic Database, <www.db.ndri.curtin

edu.au> In addition to this Ms Stearne has been involved in a number of research projects

at national, state and local level Research includes the identification of the elements of best

practice in Indigenous substance misuse interventions (2003) and the areas of greatest need in

Indigenous substance misuse (2009) Ms Stearne has also conducted a number of

Indigenous-specific drug and alcohol program evaluations, including the evaluation of the effectiveness of

the fuel substitution program COMGAS From September 2005 until late 2008, Ms Stearne was

based in Alice Springs There she supported a local Aboriginal community organisation, enabling

them to control and conduct their own research

Karen Ugle-Strachan

Karen Ugle-Strachan is an Aboriginal psychologist from south-west Western Australia Karen

moved to Perth to study Psychology as a mature-aged student and graduated with a Bachelor of

Psychology Karen gained full registration as a psychologist in 2007 She is an Associate Member

of the Australian Psychological Society and a member of the Australian Indigenous Psychological

Association (AIPA) She has a passion for psychology and counselling for Aboriginal people

Karen has worked in various departments as a therapist and cultural consultant She is now

happily working for Yorgum Counselling Service in East Perth

Professor Iain Walker

Iain Walker is a Scottish-born Wadjella living and working on Noongar land He has recently

started work as a Research Group Leader for Social Sciences and Sustainability at the CSIRO

in Floreat, Perth Previously, he was a professor of psychology at Murdoch University, where

he worked since coming to Perth in 1986 He has been researching prejudice and intergroup

relations for nearly three decades He is co-author of the second edition of Socialcognition

and co-editor of Socialrepresentationsandidentity:Content,processandpower and Relative

deprivationtheory:Specification,developmentandintegration

Associate Professor Roz Walker (author and editor)

Associate Professor Roz Walker has over 25 years’ experience as a researcher and educator

working with Aboriginal communities building local capacity within both Aboriginal and

non-Aboriginal organisations Roz worked at the Centre for non-Aboriginal Studies for many years, and

was Deputy Director of the Curtin Indigenous Research Centre for several years prior to working

with Kulunga Research Network at the Telethon Institute for Child Health Research Her key

areas of interest include developing transformative and decolonising strategies at individual,

organisational and community levels as well as promoting system level change Roz has taught

extensively at undergraduate and graduate levels in Aboriginal community management and

development and early years education in remote areas She has worked in Aboriginal education

in teaching, curriculum development, academic coordination, research and evaluation She has extensive experience in translating research into policy and practice Most recent examples

include her involvement in communicating and disseminating the WesternAustralianAboriginal

ChildHealthSurvey throughout Western Australia to communities and key stakeholder groups

and implementing the Australian Early Development Index and the Indigenous AEDI adaptation

across the Pilbara One of her key projects over the last three years has been the StayingonTrack

substance use reduction project funded through BHP Billiton Iron Ore Health Partnership with Telethon Institute for Child Health Research This has involved working with young people and relevant agencies and stakeholders in Hedland, particularly the Hedland Youth Leadership Coalition and the Hedland Youth Stakeholder Action Group, assisting the development of a Youth Charter and Youth Strategy Roz was co-editor of Gunada Press at Curtin University

and provided extensive support to WorkingWithIndigenousAustralians:AHandbookfor

Psychologists (2000) edited by Associate Professor Pat Dudgeon

Rosemary Wanganeen

Rosemary describes herself as a Griefologist—one who studies and applies holistic approaches

to loss and grief counselling and educational models Her commitment to transforming a preceding loss and grief model has enabled her to modernise her now innovative and unique Seven Phases to Reconciling Losses with Grief for the 21st century Her study and research

in weaving holistic approaches into a standard mainstream loss and grief model has led

to the School of Psychology at the University of South Australia awarding her the title of Adjunct Research Fellow Her passion and commitment to loss and grief had her involved in

a number of research projects and her proudest moment is her Seven Phases being described

in a publication called AngerandIndigenousMen She has presented her work to a range of

audiences, both nationally and internationally

She spent a year as a research officer with the Committee to Defend Black Rights in Sydney, which became instrumental in forcing the government to call for the Royal Commission into Aboriginal Deaths in Custody She spent a further two and a half years on the Royal

Commission, which enabled her to ‘see, feel and hear’ intense grief from families around Australia about the death and dying of other family members She also became aware that many

if not all families had members with compounded suppressed unresolved grief and so it was just

a matter of time before she was able to acknowledge a major gap in the services to herself and many Aboriginal people around Australia This gap was any form of counselling for Aboriginal people, but more specifically there was no culturally appropriate counselling and, perhaps for her, what was more challenging was identifying that there was no culturally appropriate loss and grief counselling model This inspired Rosemary to apply her personally developed Seven Phases and become the founding Director of the Australian Institute for Loss and Grief P/L (est 2006), which formerly traded as the Sacred Site Within Healing Centre (est 1993) The Institute

is based at Port Adelaide Rosemary has been an educator and counsellor for 16 years in addition

to the five years she endured healing her own personal suppressed unresolved grief, giving her 22 years working with loss and grief

She is a mother of three and grandmother of five

Associate Professor Edward Wilkes

Edward Wilkes is an Associate Professor working for the National Drug Research Institute at Curtin University He has a wide and extensive knowledge of Aboriginal Health Ted was a member of the Working Party that produced the National Aboriginal Health Strategy 1989 and

he chaired the working group that produced the ComplementaryActionPlan for the National

DrugStrategy2003–2009 His work with the Derbarl Yerrigan Health Service (1986–2002)

as Director allowed him to advocate for change to bring about necessary gains in health and quality of life for Aboriginal Australians Ted continues to advocate as an Aboriginal health

Australian National Council for Drugs and is the Chair of the National Indigenous Drug and

Alcohol Committee

Dr Michael Wright

Michael is a Yuat Nyungar man from Western Australia His mother’s and grandmother’s

booja (country) is located just north of Perth, in the area known as the Victoria Plains, which

includes the townships of Mogumber and New Norcia Michael has extensive experience in

the area of Aboriginal mental health and Aboriginal health He has worked as a social worker

in an inner-city hospital and was the manager of an Aboriginal mental health service located

within the Derbarl Yerrigan Health Service in Perth The mental health program was both

innovative and unique, because it was the first Aboriginal community-controlled service to

provide a psycho-social and emotional inreach service to Aboriginal families living with a

serious mental illness in the Perth area He is currently undertaking his PhD exploring the

experiences of caregiving for Aboriginal people living with a serious mental illness In 2009 he

was awarded an NHMRC Training Fellowship His post-doctoral project will investigate the

effectiveness and appropriateness of the publicly funded mental health system in its provision

of services to Aboriginal people living in a defined region in the Perth metropolitan area The

project will involve Aboriginal families, Aboriginal and non-Aboriginal service providers,

policy-makers and managers

Professor Stephen Zubrick

Professor Zubrick holds an appointment in the Curtin University of Technology Centre for

Developmental Health at the Institute for Child Health Research where he is the Head of the

Division of Population Science He was trained in the USA at the University of Michigan,

where he completed Masters degrees in speech pathology and audiology, followed by doctoral

and postdoctoral work in psychology Steve has worked in Western Australian hospital and

outpatient health and mental health settings for many years before commencing work in 1991 at

the Telethon Institute for Child Health Research His research interests include the study of the

social determinants of health and mental health in children, systematic studies of youth suicide,

and large-scale psychosocial survey work in non-Indigenous and Indigenous populations

He chairs the Consortium Advisory Group that is implementing the Longitudinal Study of

Australian Children and is a member of the Steering Committee for the Longitudinal Study of

Indigenous Children He is particularly interested in the translation of psychological and social

research findings into relevant and timely policies and actions on the part of governments and

private agencies

ABS Australian Bureau of Statistics

AHMAC Australian Health Ministers’ Advisory Council

AIATSIS Australian Institute of Aboriginal Torres Strait Islander StudiesAIHW Australian Institute of Health and Welfare

AIMHI NT Australian Integrated Mental Health Initiative in the Northern Territory AIPA Australian Indigenous Psychologists Association

AIRRFI Awareness, Identify, Reclaim, Reconcile, Forgive, Inspire

AMSANT Aboriginal Medical Services Alliance of the Northern Territory ANPPEIMH Australian Network for Promotion, Prevention and Early Intervention for

Mental Health

APS Australian Psychological Society

ATSIC Aboriginal and Torres Strait Islander Commission AUSIENET Australian Network for Promotion, Prevention and Early Intervention for

Mental Health

CARPA Central Australian Rural Practitioners Association

DEETYA Department of Employment, Education, Training and Youth Affairs

DRUID Darwin Region Urban Indigenous Diabetes

DSM IV-TR DiagnosticandStatisticalManualofMentalDisorders, Fourth Edition, Text

Revision

HRSCEET House of Representatives Standing Committee on Employment, Education and

TrainingICD-10 International Statistical Classification of Diseases and Related Health Problems

10th Revision

MCEETYA Ministerial Council on Education, Employment, Training and Youth Affairs

NACCHO National Aboriginal Community Controlled Health Organisation

NAHSWP National Aboriginal Health Strategic Working Party

NATSIHC National Aboriginal and Torres Strait Islander Health Council

NATSIHS National Aboriginal and Torres Strait Islander Health Survey

NATSISS National Aboriginal and Torres Strait Islander Social Survey

NPSMHW National Practice Standards for the Mental Health Workforce

NSFATSIH National Strategic Framework for Aboriginal and Torres Strait Islander Health

NSPS National Suicide Prevention Strategy (formerly National Youth Suicide

Prevention Strategy, NYSPS)OATSIH Office for Aboriginal and Torres Strait Islander Health

RANZCP Royal Australian and New Zealand College of Psychiatrists

RCIADIC Royal Commission into Aboriginal Deaths in Custody

SCRGSP Steering Committee for the Review of Government Service Provision

SEWB RCs Emotional and Social Wellbeing Regional Centres

WAACHS West Australian Aboriginal Child Health Survey

The purpose of the book

There is a lack of suitable resources to educate and assist health professionals to work with Aboriginal and Torres Strait Islander people experiencing social and emotional wellbeing issues and mental health conditions, across all life stages Further, those resources currently used by clinicians in mental health have little cross-cultural validity

The purpose of WorkingTogether:AboriginalandTorresStraitIslanderMentalHealth

andWellbeingPrinciplesandPractice is to provide an appropriate resource for a range of health

professionals who work with Aboriginal and Torres Strait Islander people, including Aboriginal and Torres Strait Islander health workers, counsellors, and other staff of Indigenous health services It provides a comprehensive, culturally relevant, and specific resource to support the provision of services to Aboriginal and Torres Strait Islander people who are striving to effectively deal with the effects of past policies and practices The book is also suitable for students studying in relevant fields

The book has been written by a range of acknowledged experts in the mental health field and thus presents a variety of perspectives relating to the social and emotional wellbeing and mental health issues for Aboriginal and Torres Strait Islander people A strong Indigenous voice permeates the book Indeed the high number of Aboriginal and Torres Strait Islander authors and collaboration between authors has made this text unique

A social and emotional wellbeing perspective

WorkingTogether:AboriginalandTorresStraitIslanderMentalHealthandWellbeingPrinciples andPractice is a unique and invaluable resource to educate and assist health professionals to

work with Indigenous Australians

Indigenous Australian people usually take a holistic view of mental health To reflect this,

we have adopted a social and emotional wellbeing approach to mental health in this book The holistic view incorporates the physical, social, emotional and cultural wellbeing of individuals and their communities

In this respect, Tom Calma, the former Aboriginal and Torres Strait Islander Social Justice Commissioner, has observed that we need to break down ‘health silos’; he argues that we must break down the silos that separate out mental health, family violence, and substance abuse services He proposes that these should be integrated within comprehensive primary health care services to reflect the fact that these issues are often linked (Calma, 2005)

The holistic view of health of Indigenous Australians is evident in their capacity to sustain self and community in the face of a historically hostile and imposed culture Unique protective factors contained within Indigenous cultures and communities have been sources of strength and healing when the effects of colonisation and what many regard as oppressive legislation have resulted in loss, grief and trauma

Aboriginal writers in this book remind us of the importance of recognising existing

frameworks of healing in Indigenous communities, and how culture and spirituality in relation to

social and emotional wellbeing are ongoing sources of strength For instance, the late Mr Joe Roe in

Chapter 17 of this book argued that successful counselling and community development needs to

include empowering Aboriginal peoples to bring back the systems of care, control and responsibility

that once existed His model and those of Lorraine Peeters (Chapter 20) and Rosemary Wanganeen

(Chapter 19) are examples of how traditional ways of healing involve addressing people’s emotional,

spiritual, physical, and social needs—they are holistic and focus on wellbeing

Guiding principles

The NationalStrategicFrameworkforAboriginalandTorresStraitIslanderPeoples’Mental

HealthandSocialandEmotionalWellBeing2004–2009 contains nine guiding principles that

further emphasise the holistic and whole-of-life view of health held by Aboriginal and Torres

Strait Islander People The Framework was endorsed by Commonwealth and state/territory

governments and represented agreement among a wide range of stakeholders on the broad

strategies that needed to be pursued

The nine principles enunciated in the Framework guided the development of Working

Together:AboriginalandTorresStraitIslanderMentalHealthandWellbeingPrinciplesand

Practice The nine principles are:

1 Aboriginal and Torres Strait Islander health is viewed in a holistic context that

encompasses mental health and physical, cultural and spiritual health Land is central to

wellbeing Crucially, it must be understood that while the harmony of these interrelations

is disrupted, Aboriginal and Torres Strait Islander ill health will persist

2 Self-determination is central to the provision of Aboriginal and Torres Strait Islander

health services

3 Culturally valid understandings must shape the provision of services and must guide

assessment, care and management of Aboriginal and Torres Strait Islander people’s health

problems generally and mental health problems in particular

4 It must be recognised that the experiences of trauma and loss, present since European

invasion, are a direct outcome of the disruption to cultural wellbeing Trauma and loss of

this magnitude continue to have intergenerational effects

5 The human rights of Aboriginal and Torres Strait Islander peoples must be recognised

and respected Failure to respect these human rights constitutes continuous disruption to

mental health (as against mental ill health) Human rights relevant to mental illness must

be specifically addressed

6 Racism, stigma, environmental adversity and social disadvantage constitute ongoing

stressors and have negative impacts on Aboriginal and Torres Strait Islander people’s

mental health and wellbeing

7 The centrality of Aboriginal and Torres Strait Islander family and kinship must be

recognised as well as the broader concepts of family and the bonds of reciprocal affection,

responsibility and sharing

8 There is no single Aboriginal or Torres Strait Islander culture or group, but numerous

groupings, languages, kinships and tribes, as well as ways of living Furthermore, Aboriginal

and Torres Strait Islander peoples may currently live in urban, rural or remote settings, in

urbanised, traditional or other lifestyles, and frequently move between these ways of living

9 It must be recognised that Aboriginal and Torres Strait Islander peoples have great

strengths, creativity and endurance and a deep understanding of the relationships between

human beings and their environment (NationalStrategicFrameworkforAboriginaland

TorresStraitIslanderPeoples’MentalHealthandSocialandEmotionalWellBeing2004–

2009, p 6)

Background to the book

Although this book came about because chapter authors gave their time and shared their

wisdom about the social and emotional wellbeing of Indigenous Australians, WorkingTogether:

Our task was to identify, commission and coordinate key Indigenous and non-Indigenous experts and stakeholders in the mental health sector to provide written contributions to the book A list of potential contributors was drawn up at the commencement of the project The list included clinicians, and cultural and educational experts Both Indigenous and non-Indigenous experts who are stakeholders in the mental health sector were considered The list was compiled from the editors’ knowledge of people working in the field, their extensive networks among Indigenous communities and academic personnel, internet searches, and recommendations from the Expert Reference Group (ERG)

The scope of the book was to include content relating to historical and present-day social health and emotional wellbeing issues and the evolution of current Indigenous social and emotional wellbeing and mental health policy directions It was to incorporate specific clinical mental health assessment processes and culturally appropriate programs and interventions

In addition to health professionals who work with Aboriginal and Torres Strait Islander people, the target audience for the book was to include Vocational Education Training (VET) and Tertiary Education Training (TET) students to assist them to understand a variety of perspectives relating to social and emotional wellbeing and mental health issues for Aboriginal and Torres Strait Islander people The book will also be an invaluable resource for professional development in key discipline areas associated with Aboriginal and Torres Strait Islander social and emotional wellbeing such as mental health nursing, occupational therapy, psychiatry, general medicine, psychology, and social work

To achieve these things, we drew on the expertise of a range of individuals, groups and organisations including:

• the OATSIH Expert Reference Group for Improving the Capacity of Workers in Indigenous Communities

• relevant individuals from organisations listed in Chapter 21 of this book

• the ACER Standing Committee on Indigenous Education

• an Internal Advisory Group at the Telethon Institute of Child Health Research in Western Australia

• those located through our existing networks

We developed a framework for the book (section and chapter themes) and invited key people to be chapter leaders These leaders took responsibility for the chapters, although they generally worked with other authors who we also had identified as eminent people for the various chapters

Individual draft chapters were sent out for external review to at least one and usually two reviewers who were recognised experts in relevant areas Authors were invited to make changes to their chapters on the basis of reviewers’ and editors’ comments

When all chapters had been completed, the draft manuscript was sent to several sites for

market testing We asked market testers:

• to provide an overall assessment of the manuscript in about 250 words

• to list the major uses of the work

• whether the work could be better organised or sequenced differently, and if so, in

what way

• to comment on readability and writing style/s

• whether they would recommend this book to practitioners and students working in

Indigenous mental health

• what would set this book apart from others in its field

• to which special areas or fields the work would make a good contribution

Each author, or group of authors, speaks with their own voice Although authors were

given guidelines about the book before they commenced their work, we felt it was important

to encourage diversity rather than conformity in the perspectives they presented Authors

were, however, encouraged to frame their chapters in accepted wisdom rather than around

untested claims

The structure of the book

WorkingTogether:AboriginalandTorresStraitIslanderMentalHealthandWellbeingPrinciples

andPracticeis divided into four parts

Part 1 contains four chapters that outline the historical, social, cultural, and policy

contexts that have shaped Aboriginal and Torres Strait Islander mental health and wellbeing

In Chapter 1, Robert Parker examines the concepts of physical and mental health for

Aboriginal and Torres Strait Islander people, both before and after the European colonisation of

Australia Parker points to some national and international innovative thinking that may assist

Aboriginal and Torres Strait Islander people to regain the health that has been so significantly lost

In Chapter 2, Debra Rickwood, Pat Dudgeon and Heather Gridley discuss the history of the

discipline and practice of psychology with Australian Aboriginal and Torres Strait Islander people

in relation to mental health The key engagements of psychology with Aboriginal and Torres Strait

Islander people are outlined The authors suggest positive ways that psychologists can work together

to bring about improved social, emotional and spiritual wellbeing for Indigenous Australians

Chapter 3 by Pat Dudgeon, Michael Wright, Yin Paradies, Darren Garvey and Iain

Walker helps us understand the contemporary issues faced by Aboriginal and Torres Strait

Islander Australians by providing an overview of the social, cultural and historical contexts

that have shaped their lives today Brief overviews are given of pre-contact times, colonisation,

resistance and adaptation, shifting government policies, and the struggle for recognition

Indigenous identity and meanings of belonging in country, community and family are also

briefly covered Contemporary issues confronting Indigenous people are included, with

particular attention to racism

Chapter 4 by Steve Zubrick, Kerrie Kelly and Roz Walker outlines the role of policy in

setting directions for and achieving change in Aboriginal and Torres Strait Islander mental

health Key national policies, frameworks and reports addressing the mental health and social

and emotional wellbeing of Aboriginal and Torres Strait Islander people are presented

Part 2 contains seven chapters on a number of issues that are particularly relevant to

Aboriginal and Torres Strait Islander mental health and wellbeing

In Chapter 5, by Robert Parker, common types of mental disorders, such as anxiety

disorders, mood disorders, psychosis and personality disorders are outlined These disorders are

discussed in terms of what Aboriginal and Torres Strait Islander people may have experienced in

traditional as well as in contemporary contexts

Chapter 6 explores current understandings of the determinants of Aboriginal and Torres Strait Islander social and emotional wellbeing and its development Its authors, Stephen Zubrick, Pat Dudgeon, Graham Gee, Belle Glaskin, Kerrie Kelly, Yin Paradies, Clair Scrine and Roz Walker, show that the determinants of this wellbeing are multiple, interconnected, and develop and act across the life course from conception to late life The authors also show that the risk and protective factors impacting on the wellbeing of Aboriginal and Torres Strait Islander people differ in important ways from those endorsed in mainstream concepts of mental health.

Chapter 7 by Sven Silburn, Belle Glaskin, Darrell Henry and Neil Drew examines epidemiological trends in suicide and attempted suicide for Indigenous and non-Indigenous Australians and in other nations such as Canada, the USA and New Zealand The meaning of suicide within Indigenous community contexts is explored, and the authors show how this can inform preventive action, early intervention and post-intervention

Chapter 8 by Jenny Adermann and Marilyn Campbell outlines issues of excessive anxiety in Indigenous youth It describes what an anxiety disorder is and its consequences, and how Indigenous youth seem to be at risk for developing such disorders Issues concerning the delivery of traditional prevention and intervention programs are discussed and possible interventions are provided

In Chapter 9, Edward Wilkes, Dennis Gray, Sherry Saggers, Wendy Casey and Anna Stearne examine substance misuse and mental health among Aboriginal Australians, as well as related harms and the social determinants of mental health and substance misuse They also examine a range of services that have been developed to address these issues, and the National Drug Strategy’s demand, supply and harm reduction framework They argue that a multi-systemic strategy is required that addresses issues of cultural security, and that evidence-based practice is needed to enhance treatment outcomes Until the social and structural determinants

of good mental health are addressed, the co-morbidity of substance misuse and mental health among Aboriginal Australians will linger

Chapter 10 by Judy Atkinson, Jeff Nelson and Caroline Atkinson focuses on how the effects of experiencing trauma are transmitted within and across generations The chapter introduces the reader to a selection of views and conceptions of trauma, and theories of its transgenerational transfer It also explores the links between unresolved childhood trauma and participation in violence, sexually inappropriate behaviour, and incarceration as adolescents and adults The second part of the chapter discusses the challenges associated with working in Indigenous communities, and it gives an example of a program that is achieving positive results.Chapter 11 by Kyllie Cripps briefly examines the context in which Indigenous family violence occurs In particular, it explores how Indigenous people define and contextualise the violence they or their family members are experiencing This context is important in considering pathways forward for healing for the victim, their families, and the broader kin network who inevitably feel the ripple effects of such violence

Part 3 contains five chapters that focus on practice within the field

Chapter 12 is about working as a culturally competent mental health practitioner The authors, Roz Walker and Christopher Sonn, address such workforce issues as working in a multidisciplinary team; developing core competencies, knowledges, skills, understandings and attributes regarded as essential for practitioners; and the relations between the disciplines and professions and between those professions and Aboriginal and Torres Strait Islander people The chapter also provides a range of tools and strategies, and a reflective framework to assist students and practitioners from various disciplines to develop key competencies

Chapter 13 by Pat Dudgeon and Karen Ugle focuses on communication and engagement with Aboriginal and Torres Strait Islander people in urban contexts Aboriginal and Torres Strait Islander people living in urban contexts may not portray stereotypical images of what Aboriginal and Torres Strait Islander people look like or live like; however, urban identity is very strong and people have

strong territorial affiliations Cultural concepts such as kinship affiliations, community obligations and

values of Aboriginal and Torres Strait Islander people living in urban contexts are outlined

Chapter 14 by Neil Drew, Yolonda Adams and Roz Walker addresses issues of mental

health assessment with Indigenous Australians The authors examine the history of assessment

and testing with culturally diverse groups, and they explore a range of emergent principles and

guidelines for practice to improve and govern assessment practices with Aboriginal and Torres

Strait Islander people They note that assessment and practitioners conducting assessment must

be repositioned (and reposition themselves) to play an important role in the development of

procedures and practices in the provision of mental health care for Aboriginal and Torres Strait

Islander people in Australia

Chapter 15 is based on the work of the late Mark Sheldon and concerns psychiatric health

assessment in remote Aboriginal communities Sheldon’s work is informative for all mental health

and wellbeing practitioners intending to work with Aboriginal people, especially in service delivery

in remote areas Sheldon sought alternative ways of working clinically in the cross-cultural setting

of traditional and semi-traditional Aboriginal society He worked to develop approaches to suit

the setting His work required adjustments in history-taking, mental state examination, diagnosis,

management, professional boundaries, and the way he worked with his colleagues

In Chapter 16, Sue Ferguson-Hill considers factors relating to perinatal mental health,

culture, environmental context, and ways of working with Aboriginal and Torres Strait

Islander families Protective and risk factors related to perinatal mental health are discussed

from the perspective of mother, child and father Ways of strengthening wellbeing and of

recognising and managing perinatal distress and perinatal depression are explored The

chapter also briefly explores pathways and models of care, screening, and tools of assessment

used in the perinatal period

Part 4 presents examples of models and programs for practitioners working with different

groups The models are responses by individuals and groups of people to a perceived need Some are

based on people’s personal experiences; others are based on existing models of healing that have been

reinterpreted to meet the specific contexts and needs of Aboriginal and Torres Strait Islander people

Chapter 17 presents a cultural model for keeping the spirit strong The Ngarlu program

was developed by Karajarri man Joe Roe (deceased) as an aid to working with Aboriginal men

in their recovery from a major psychiatric illness It is a path to spiritual, emotional and social

wellbeing The model has both practical application and policy impact; for instance, it underpins

the current framework for the Western Australian Aboriginal drug and alcohol strategy

Chapter 18 by Maria Morgan and Neil Drew outlines a model for engagement with

remote Aboriginal communities in the East Kimberley region of Western Australia The model

was developed and implemented over the last four years as a partnership between Aboriginal

communities and the University of Notre Dame Australia The engagement model is based

on authentic program ownership by the Aboriginal communities to reduce the incidence of

youth suicide The model is holistic, based on a multifaceted wellness framework that includes

personal, group and collective wellness

Chapter 19 is by Rosemary Wanganeen It describes the potential of a holistic loss and

grief model to heal anger, rage and violence and empower people who see and find themselves as

victims The Seven Phases to Healing model of self-healing and spiritual reconnection provides

a basis for elements related to counselling processes The basis for Wanganeen’s model is five

years of her personal life experiences and over 15 years in professional practice Drawing on this

deeply personal experience, this chapter emphasises the importance of positive self-healing and

each person’s responsibility for this

Chapter 20 by Lorraine Peeters outlines the Marumali program which she developed as

an Aboriginal model of healing for the Stolen Generations The program was examined and

endorsed in 2000 by psychiatrist Professor Beverley Raphael (co-author of theWaysForward

Report) as being safe and effective practice The program was also endorsed by the National

Aboriginal Community Controlled Health Organisation (NACCHO) in 2001 as being a positive training and education model in social and emotional wellbeing The Marumali program is used extensively in the Koori justice system in Victoria.

Chapter 21 provides examples of mental health services and programs that provide specific assistance for Aboriginal and Torres Strait Islander people and the practitioners who work with them There are different programs and services for different groups and types of mental health issues The information has been provided by the organisations or has been gleaned from their websites The services listed in this chapter are not the only ones available but the chapter does provide a starting point for people looking for information or a place to go

Care and protection

Issues within this book may have an impact on readers and self-care mechanisms may be useful Some Indigenous students and practitioners may have experienced loss, grief and trauma themselves Some non-Indigenous people may find aspects of the book challenging and should also be aware of the need for self-care Teachers’ duty of care to students may require them to alert students to the possibility that some chapters may have an impact on them as they reflect on their own experiences When working with clients, practitioners need to acknowledge the need for self-care as discussed in Chapter 12, ‘Working as a Culturally Competent Mental Health Practitioner’ Chapter 21, ‘Mental Health Programs and Services’, provides information about support for mental health and wellbeing professionals who work with Aboriginal and Torres Strait Islander people

Terminology

In Australia, there are many Indigenous nations, languages and cultures This is shown clearly

in Horton’s map of Australia’s Indigenous languages which indicates the general location of larger groupings of people but may include smaller groups such as clans, dialects, or individual languages in a group

It is difficult to identify terminology that is appropriate and acceptable to all these groups Indigenous Australian peoples are people of Aboriginal and Torres Strait Islander descent, who identify as Aboriginal or Torres Strait Islander, and who are accepted as an Aboriginal or Torres Strait Islander person in the community in which they live, or have lived

In this book, a number of different terms have been used when referring to Indigenous Australian peoples We have chosen Aboriginal and Torres Strait Islander in the title of the book

to indicate the distinctiveness of these two major groups of people and to respect what term most Aboriginal and Torres Strait Islander people prefer to use Authors have used a range of terms and in general we have retained their language, although this has been changed sometimes to aid the flow of text for the reader

Overall, our intent has been to use language that accords respect and dignity to Australia’s Indigenous peoples

The term ‘Stolen Generations’ is used to refer to Aboriginal and Torres Strait Islander peoples affected by past government removal policies and practices The plural ‘Generations’ is used to draw attention to the transgenerational impacts of past removal practices

References

Calma, T (2005).Indigenousmentalhealth Speech by Mr Tom Calma at the Djirruwang Aboriginal

Health Program, Charles Sturt University, Student Conference, 29 September 2005, <www.hreoc.gov.au/about/media/speeches/social_justice/indigenous_mental_health.htm>

Social Health Reference Group for National Aboriginal and Torres Strait Islander Health Council

and National Mental Health Working Group (2004) NationalStrategicFrameworkfor

AboriginalandTorresStraitIslanderPeoples’MentalHealthandSocialandEmotionalWell Being(2004–2009), <www.health.gov.au/internet/main/publishing.nsf/content/health-

oatsih-pubs-wellbeing>

Part 1:

History and Contexts

that have shaped Aboriginal and Torres Strait Islander mental health and wellbeing

encompassing mental health and physical, cultural and spiritual health This holistic concept does not just refer to the whole body but is in fact steeped in harmonised inter relations which constitute cultural wellbeing (Swan & Raphael, 1995, Ch 1)

Australian Aboriginal and

Torres Strait Islander Mental

Health: An Overview

1

RobertParker

OVERVIEW

This chapter initially examines the concepts of physical and mental health for Aboriginal

and Torres Strait Islander peoples over the vast majority of the last 40,000 years or so The

devastating consequences for Aboriginal and Torres Strait Islander peoples of the European

colonisation of Australia are then described The chapter concludes with some innovative

thinking from Australia and overseas that may assist Aboriginal and Torres Strait Islander

peoples to regain the ‘health’ that has been so significantly lost

MENTAL HEALTH AS A HUMAN RIGHT

It has been well recognised through the recent progress of the human race to set some

benchmarks for the higher aspirations of mankind in general that health is an essential

component of human development and an important ambition for individuals and their

society The International Conference on Primary Health Care at Alma-Ata in 1978 stated

that ‘health, which is a state of complete physical, mental and social wellbeing, and not merely

the absence of disease or infirmity, is a fundamental human right and the attainment of the

highest possible level of health is a most important world wide goal’ This concept was recently

reaffirmed in the United Nations Declaration on the Rights of Indigenous Peoples in 2007

through Article 7, which states: ‘Indigenous individuals have the rights to life, physical and

mental integrity, liberty and security of the person’ (United Nations 2007, p 5)

Archaeological evidence suggests that Aboriginal people have been present in Australia

for the last 45,000–50,000 years The ethnographic evidence from early contact suggests that

Aboriginal people who survived infancy were relatively fit and disease-free (Flood 2006, p 121)

Further, Australia’s native foods supported a nutritious, balanced diet of protein and vegetables

with adequate vitamins and minerals with little salt, sugar and fat Life on the move kept people

physically fit (p 122)

In terms of mental health, traditional Aboriginal culture had a number of strong

reinforcing factors that have been well defined by Associate Professors Helen and Jill Milroy

(Milroy et al., 2003) Aboriginal sense of self was seen in a collective sense, intimately connected

to all aspects of life, community, spirituality, culture and country The culture also provided

for everyone by sharing rules and relationships Kinship was of prime importance in defining

social roles Aboriginal people were also given a sense of meaning and understanding of life

experience through their connection to country and their Dreaming Spiritual beliefs offered

guidance and comfort and held a sense of connectivity and belonging despite distress, death and loss Lore, the body of knowledge that defined the culture, was highly valued, as were the tribal elders who contained and interpreted the Lore Customary law defined rules and consequences Over 200 traditional languages and other methods of communication allowed a rich expression

of interaction in this social context, and formal ceremony allowed a method of dealing with life’s transitions through birth, initiation and death Men and women had defined economic and cultural roles Children were well protected within the group with a range of aunties and older siblings able to take over the childcare role if the mother was stressed

These concepts mean that Aboriginal society before European contact provided the optimal conditions for mental health that have been enunciated in later documents such as

WaysForward Swan and Raphael (1995) comment:

[T]he Aboriginal concept of health is holistic, encompassing mental health and physical, cultural and spiritual health This holistic concept does not just refer to the whole body but is in fact steeped in harmonised inter relations which constitute cultural well being These inter relating factors can be categorised largely into spiritual, environmental, ideological, political, social, economic, mental and physical Crucially, it must be understood that when the harmony of these inter relations is disrupted, Aboriginal ill health will persist (p 19)

In the context of such parameters for general mental health, reports of severe mental illness affecting Aboriginal people in the traditional cultural setting do exist Jones and de la Horne (1972, 1973) describe the occurrence of schizophrenia and mood disorders in Central Desert cultures Eastwell (1976, 1977) reported on a potential familial susceptibility to delusional disorder in Arnhem Land Meggitt (1962) also described Aboriginal people suffering from psychosis and a probable dissociative disorder due to severe cultural stress in the Centre These reports appear to indicate that the experience of severe mental illness was a rare event in traditional Aboriginal culture Aboriginal society and culture probably afforded protection for the less severe neurotic and adjustment disorders through the cultural permission to release hostile feelings rather than bottling them up and through ascribing unusual events such as premature death to sorcery, a concept that carried significant conviction within the culture (Eastwell, 1988)

It is thought that a population may have been present in Torres Strait for 70,000 years Statistics suggest that there may be better health, social and educational outcomes for current Torres Strait Islander peoples who continue to reside in their own traditional country (Trewin & Madden, 2005) It has been suggested that a cross-border treaty between Papua New Guinea and Australia in 1985 that enhances Torres Strait Islander economic and social prospects through sharing of fishing rights (Altman, 2000) may be a further contributing factor to this improved health status However, this has been complicated in recent years by residents of Papua New Guinea, including those infected by HIV, moving into the Torres Strait communities to seek treatment

Marsat Ketchell (2004) reports on a number of cultural mechanisms that are important for Torres Strait Islander family members to complete for the maintenance of their mental

health These cultural issues revolve around the role of the MariGethal(Hand of the Spirit)

This is a male relative of a deceased person who has to inform relatives of a loss and make

arrangements for a funeral On the UmanGoega or day of the death, the Mari Gethal brings tidings of the deceased to the community Mai is the mourning conducted by the community

for the deceased A significant component of this is the formal dressing of the deceased, which

is an important part of healing for the deceased’s family and for the community At the Murama

Theodan or burial of the deceased, the Mari Gethal has the role of choosing the location of the

burial site and organising its decoration The funeral ritual concludes with the ThoerabauAi,

the burial feast This used to be a feast to acknowledge the work of the Mari Gethal but is now generally regarded as a source of ‘debriefing’ for the entire community At the feast, the Mari

Gethal can also assess the level of community grief and devise intervention strategies Some

time after the death, there is the Tai or Markai tombstone opening This ceremony signifies that

the deceased is finally housed and official grieving ceases There is a feast and gifts are given

to people who cared for the family of the deceased Ketchell notes that it is very important for

Torres Strait Islander people to be able to fulfil these duties; mental illness may result if the

duties are not able to be completed or if people are denounced by the clan group because they

are perceived as not having fulfilled their responsibilities adequately In addition, Ketchell

reports that Torres Strait Islanders may be affected by reports of MurrMerror UthiaTharan

(reports of sorcery affecting or being performed by a person suffering from depression) as well

as delusions of jealousy (including a preoccupation with the alleged perpetrator’s footprints)

CURRENT ISSUES

These reports of occasional mental illness in Aboriginal and Torres Strait Islander culture

notwithstanding, the decimation of Aboriginal populations, destruction of Aboriginal culture

and significant disempowerment and marginalisation of Aboriginal and Torres Strait Islander

peoples following the British colonisation of Australia has resulted in what is widely regarded as

widespread, devastating effects on the physical and mental health of Aboriginal and Torres Strait

Islander peoples The issue of the Stolen Generations is a particular recent example of physical

and psychological deprivation visited on Aboriginal children removed from their parents

The current significant disadvantage of Aboriginal health and social determinants is

well recognised Hospitalisation rates for cardiovascular disease in Aboriginal and Torres

Strait Islander were 67% higher in 2004–06 than for other Australians (AHMAC, 2008) In

2006, rheumatic heart disease was nine times more common for Aboriginal and Torres Strait

Islanders than for other Australians in the Top End of the Northern Territory and Central

Australia (p 34) Diabetes and renal failure also figure prominently in Aboriginal health

issues In 2004–05, three times as many Aboriginal and Torres Strait Islanders were reported

to have diabetes or high sugar levels compared to other Australians (p 38) Hospitalisation

rates for Aboriginal and Torres Strait Islander people with diabetes are almost six times

higher than for other Australians (p 38) End stage renal disease, often the consequence of

poorly controlled diabetes, was eight times higher for Aboriginal and Torres Strait Islander

peoples than for other Australians (p 40) Given these alarming statistics, it is not surprising

that life expectancy for Aboriginal and Torres Strait Islander people is estimated to be 11.5

years for males and 9.7 years for females less than for other Australians (p 7), an issue now

well recognised in the Close the Gap agenda (AHMAC, 2008)

Aboriginal and Torres Strait Islander disadvantage is also apparent in other social indices

The 2008 National Aboriginal and Torres Strait Islander Social Survey estimated that 25% of the

Aboriginal and Torres Strait Islander population over 15 were living in overcrowded housing

The overcrowding becomes more common/problematic in remote areas where it is estimated

that 48% of Aboriginal and Torres Strait Islanders live in such housing (ABS, 2009) In respect to

education, the National Schools Statistics Collection reported that the retention rate of Aboriginal

and Torres Strait Islander students in Year 7/8 to Year 10 was 91% compared to 99% for other

students Unfortunately, the retention rate for Aboriginal and Torres Strait Islander students from

Year 7/8 to Year 12 was only 43% compared to 76% for other students (AHMAC, 2008) Given this

trend in education, the accompanying statistics of significant Aboriginal and Torres Strait Islander

disadvantage in employment and income compared to the rest of Australia are no surprise; neither

are data from the Australian criminal justice system which show that Aboriginal and Torres Strait

Islander people are 13 times more likely to be in prison than other Australians (p 110)

Poverty and racism also provide a framework for these statistics Walter and Saggers

(2007) point to the significant association between poverty and adverse health outcomes They

note that a significant proportion of Australia’s Indigenous population live in a situation of

absolute poverty as defined by the United Nations, where they have severe deprivation of basic

human needs including food, safe drinking water, sanitation facilities, health, shelter, education

and information Some diseases, such as scabies and diarrhea, are directly related to inadequate sanitation and living conditions (p 101) The issues of Indigenous poverty appear particularly marked in rural areas In addition, the failure of a recent plethora of policies to advance Aboriginal health has been attributed to a pervasive culture of welfare colonialism, an aspect

of continuing poverty Welfare colonialism (Anderson, 1997) affects Aboriginal communities that rely heavily on the provision of public sector resources Over time, the mechanisms to deliver these overlie the traditional methods of Aboriginal governance, reducing the capacity

of the communities to develop leadership in the solutions to their problems In addition, the continuing experience of widespread racism against Aboriginal people generally within the Australian community appears to have a continuing negative effect, particularly on the mental health of Aboriginal people (Paradies, 2007)

A perception of safety is also a crucial element of wellbeing Surveys have shown that Aboriginal and Torres Strait Islander people aged over 18 are twice as likely to report being victims of violence or threatened violence than other Australians (AHMAC, 2008) A further alarming statistic in respect to child safety was that in 2006–07 the rate of substantiated child protection notifications per 1000 was 32 for Aboriginal and Torres Strait Islander children compared with six for other children (p 112)

Given the above, it is not surprising that Aboriginal and Torres Strait Islander peoples report significantly higher levels of stress than the remainder of the Australian community Fifty-two per cent of respondents in the 2004–05 National Aboriginal and Torres Strait Islander Health Survey reported at least two life stressors over the previous 12 months, while 27 per cent reported four or more life stressors over the same period (AIHW 2009) Multiple stressors were more commonly experienced in remote areas Reported stressors identified include the death of a family member or close friend, overcrowding at home, alcohol or drug-related problems, serious illness or disability, and having a family member sent to jail or currently in jail (p 23–4) The significant effect of stress

on Aboriginal children in Western Australia is also of concern TheWestAustralianAboriginalChild

HealthSurvey (WAACHS) reported that a significant number of Aboriginal children aged 4–17 years

were living in families where seven or more major stress life events had occurred over the preceding

12 months (De Maio et al., 2005) Associate Professor Helen Milroy (personal communication) refers to the phenomenon of ‘malignant grief’ being the result of persistent stress experienced in Indigenous communities Malignant grief is a process of irresolvable, collective and cumulative grief that affects Indigenous individuals and communities The grief causes individuals and communities

to lose function and become progressively worse; ultimately it leads to death Milroy further comments that the grief has invasive properties, spreading throughout the body, and that many of Australia’s Indigenous people die of this grief

The WAACHS also reports on the psychological wellbeing of members of the Stolen Generations and their families The survey noted that members of the Stolen Generations were more likely to live in households where there were problems related to alcohol abuse and gambling They were less likely to have a trusting relationship and were more likely to have been arrested for offences Members of the Stolen Generations were more likely to have had contact with mental health services The survey commented that children of members of the Stolen Generations had much higher rates of emotional/behavioural difficulties and high rates of substance abuse (p 465)

Given this level of background stress, it is not surprising that substance abuse also figures prominently as a background factor to mental illness It is well recognised that Aboriginal and Torres Strait Islander people experience harmful rates of alcohol and other substance use and that this tends to be more pronounced in rural communities (Trewin & Madden, 2005) It is also unfortunate that Aboriginal and Torres Strait Islander men are hospitalised at over four times the expected rate for population with severe mental illness related to substance abuse, and over double the expected rate for severe chronic mental illnesses such as schizophrenia (Pink & Allbon, 2008, p 112) The rates of hospital admission for severe mental illness in Aboriginal and